The rural dirt road to Garissa, Kenya can disappear in a flash when heavy rains fall, as seen in this image of a young goat herder. Traveling is not only time consuming but can be a danger for women who are trying to get to the hospital in Garissa as quickly as possible when an emergency with the birth their child occyrs. Image: Ann Weru/IRIN

(WNN) Nairobi, KENYA, EASTERN AFRICA: Sankuri village in the eastern Kenya region near the Indian Ocean is 300 kilometres (186 miles) from the nearest larger capital town of the province in Garissa. Known as a remote area that has poor phone communications with roads that are considered too rough and too often hard to follow Sankuri can at times be a dangerous place to live. Traveling to the nearest hospital with an emergency can be a large obstacle for many as many village residents have no automobiles. Some are left to use donkey carts or camels for their only transportation during emergencies.

Using the slower form of transportation the journey often takes six to seven days from the village of Sankuri to the much larger town of Garissa. Unfortunately too many people can die on the way before they can ever receive needed medical attention.

Traveling under harsh conditions for seven days is also recipe for trouble for women with obstructed delivery that can cause many complications for young mothers, including obstetric fistula.

Hasna Muktar is a local skilled TBA – Trained Birth Attendant who lives and works in Sankuri. Each day she walks to the health facility she manages and prepares her ‘traditional’ delivery room as she gets ready for a day of appointments with pregnant women in Sankuri who are beginning to show the signs of labour.

In Kenya and throughout the surrounding Eastern African countries, attaining the United Nations MDGs – Millennium Development Goals before the 2015 deadline is important to leaders and laypersons alike, especially reaching MDG-5 that targets improved maternal health, along with reduction of maternal mortality. But reaching the goals may sometimes come with a price.

“Despite such progress, Africa still bears the largest burden of maternal deaths in the world, with over 50 per cent of the global maternal deaths occurring on the continent,” says the February 2012 meeting of experts from the UN Economic and Social Council Economic Commission for Africa. Although the rate of deaths for mothers has been large, newer data from UNICEF may now be showing better numbers, especially for child mortality.

Only Rwanda so far has hit the MDG-4 that targets a reduction in child mortality. Today Kenya is currently engaging in concerted efforts to reach their goals through the use of health education, sanitation awareness and TBAs in regions where doctors and other medical workers cannot be available.

Respect for Kenya’s rural birth attendants

As the scorching sun set in the horizon, a group of eight pregnant women in late-term pregnancies walk into Hasna’s expansive compound which houses her delivery room, a consultation room and a conference room where she educates both pregnant and non-pregnant women on family planning, home sanitation, and women reproductive and family health.

Hasna’s service is respected by the women in Sankuri village. Most have their own set of rules which are guided by cultural belief that a traditional birth attendant has a better ability to offer good antenatal care and safe delivery services than a hospital without the hassle and danger of the long trip to the Garissa.

Because the region has used midwives for centuries to help in the birth of children more modern birth attendants are accepted and preferred.

Although safe deliveries have become much more common, Hasna does face many clear and real challenges. Her health facility is built only from rudimentary sticks and grass. There is also no running water with as only source of water is a shallow well nearby. Electricity also is not available for the delivery room.

With no electricity Hasna most often in the past used a kerosene lamp at night to attend to health emergencies and for childbirth deliveries. Sometimes just getting to her health facility from her own home can prove to be a challenge at night if the moon is dark.

“For twenty five years I have been using kerosene lamp[s] and sometime[s] bright lights from the moon,” outlines Hasna. “I have been bitten three times by snakes and that affected my work inconveniencing many pregnant women in Sankuri village. The kerosene lamp had its health problem both to me and a mother with her new born baby,” continued Hasna. “I have contracted respiratory infection[s] on various occasions and also the use of moonlight is quite tricky as I have to conduct deliveries in open space [outside]. I use moonlight only when kerosene is out of stock or when I contract a respiratory sickness,” she added.

Young pastoralist teenage girls and a younger sister from the northern province of Kenya gather water to bring home. This is the age group that make up a majority of Hasna Muktar’s newest and youngest mothers. Image: USAID

Using new solar technology to see at night

Currently Hasna and other traditional birth attendants in the region have less to worry about. Thirty traditional birth attendants have received solar LED lamps from Afri-Ireland, an advocacy NGO – Non Governmental Organization based in Ireland that works closely with its partner PAJAN Kenya – Kenya Pastoralist Journalist Network to help introduce solar lamps into the region. The solar lamps enable the birth attendants to conduct birth deliveries with portable bright light, a very appreciated feature.

Using energy from the sun, which is abundant in the arid land of northeastern Kenya, each lamp comes with its own solar panel. When the solar panel is directed at the sun for approximately five hours a lamp becomes fully charged, which enables the lamp to be used as a bright light for the next 12 hours.

Most often the lamps are used for a nighttime birth, an emergency night health crisis or during nighttime women education classes where, in Hasna’s case, more than twenty pregnant women regularly congregate to learn about reproductive and family health.

“Solar lamps have made my deliveries and women education work simple as I charge it during the day and start using it at night,” Hasna elaborated. “I have used the solar lamp given to me to attend to 185 deliveries in Sankuri village and offering women education without cost implication. In the past we use to worry on the cost of the kerosene but now everything is in front of our door.”

The solar lamps have also caused the price to actually go down for Hasna’s services.

“I used to charge some 425 Kenya shillings for every single delivery due to high cost incurred in buying kerosene which is procured from Garissa… …But with [the] introduction of solar LED lamp[s] I charge only 255 Kenya shillings [equivalent to $3 USD]. 185 women have [now] enjoyed the reduced cost…,” outlined Hasna.

Afri-Ireland’s partner PAJAN Kenya, also helps educate traditional birth attendants how they can specifically use their solar lamps. Coining the project as a ‘green energy form of empowerment’, the local and grassroots women are now contributing to helping Kenya reach its UN Millennium Development Goals, especially with childbirth mortality rates.

With a clean and permanent source of light Hasna can now receive pregnant women and others for consultations, deliveries and classes at any time.

Recognizing emergencies ahead with childbirth saves lives

Halima Bishar is in her last trimester of pregnancy. On the day she went to see Hasna for what she describes as ‘cramping’ Hasna took her into her consultation room. She talked with Halima carefully using all the diagnostic tools she has available.

As a 28-year-old mother Halima is completely comfortable and relies on Hasna to help her through her birthing process. Halima gave birth previously to her other two children with no complications in Hasna’s traditional facility.

Currently two thirds of Kenya’s total maternal deaths are attributed to postpartum hemorrhage (severe loss of blood during or after labour), sepsis (bacterial infection in the blood), preeclampsia (hypertension during pregnancy), eclampsia (hypertension during birth) or a ruptured uterus.

To prevent the death of a mother, Garissa Provincial General Hospital now admits women who have a history of pregnancy complications a month ahead to stay at the hospital for observation and rest in order to prevent pre-eclampsia and eclampsia. In addition to maternal deaths, rural areas in Kenya’s northeast region have been in the past almost twice as likely to result in a fetal or infant death with statistics averaging 488 deaths per every 100,000 live births, but conditions are improving steadily.

“…in recent years, Kenya has recorded significant reduction in child mortality. According to the Kenya Demographic and Health Survey (2008-2009) the country’s under-5 mortality rate reduced from 115 deaths per 1,000 live births in 2003 to 74 in 2008-2009. Infant mortality also dropped from 77 deaths per 1,000 in 2003 to 52 deaths per 1,000 in 2008-2009,” says the UNICEF office in Nairobi, Kenya.

As a TBA in her region Hasna boasts that her record in watching over women’s reproductive health has been working.

“I have offered services here in Sankuri village for twenty-five years and I have not recorded any death[s]. I understand my customers, their background and their pregnancy timetable. I have received training and equipment to make my work professional,” she outlines.

Observing and watching her mothers closely and making arrangements for them to be referred to the hospital in Garissa if they show any elevated blood pressure, anemic signs or antepartum hemorrhage has saved lives.

Teaching mothers, as well as their families, the importance of sanitation for newborns as well as children under the age of five, along with the value of better food nutrition for both mothers and their families is also an important step forward that Hasna is now helping as a TBA to bring to the rural village of Sankuri.

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For many pregnant women in rural areas access to health facilities is a great challenge owing to the poor infrastructure. But in the little known Kapyemit region in the county of Uasin Gishu our reporter Irene Choge met Susan Tenai, a TBA – Trained Traditional Birth Attendant who in her small way IS helping to prevent both maternal and newborn deaths. This 3:12 min January 2011 video release on Youtube is a NTV Kenya production.

Additional information for this story has been provided by Afri-Ireland, Kenya Ministry of Health, U.S. CDC – Center for Disease and Control and Prevention, NTV Kenya, UN Economic and Social Council Economic Commission for Africa, CNN news, UN.org, Kenya Demographic and Health Survey, USAID, Humbolt State University with Lawrence Berkeley National Laboratory, Population Council, Friedman Benda ARTInfo and UNICEF Kenya. Additional editing and research material has been provided by WNN – Women News Network.

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WNN Kenya based freelance news correspondent, peace activist and development specialist, Abjata Khalif, is dedicated to reporting on important issues for women in the northeastern region of Kenya. His work has also been published in Reuters Alertnet as well as the Christian Science Monitor, among other publications.